Thanks very much, Doug, and thank you all for attending. First, I'd like to thank everybody who was involved in this two-year effort. It was a long and interesting effort and laborious effort, but a lot of fun. And we got to make a lot of new friends and have a lot of lively discussions. I think it's important to understand the background and some of the processes which led to the formation of this document. The scope of the document is to define the required competencies and give some guidance in terms of procedural numbers and training standards for coronary vascular, peripheral vascular, and structural interventions. That includes adult congenital heart interventions also. What this document does not attempt to address is whether or not interventional cardiology training should be extended formally for another year or for a certain amount of time. It doesn't address exact numbers of months or years that should be committed to additional training in either peripheral or structural heart intervention. It doesn't address whether or not we as a profession or as a group or a society or college should be pursuing either peripheral intervention or structural heart intervention in terms of further certification certificates. That's added the scope of this. Doug, you already did mention about the writing group. And again, my thanks to Dawn and Shami and Sahil for their leadership in the various sections. And this is the group that did a lot of the heavy lifting and the hard work that made this document happen. Special thanks to Dawn for Beth and to Teresa Callahan, who I hope is on the call, who really led us through this. And it was like leading cats. So it was a lot of work, and thank you all. It's a diverse group. You can see after the names what some of the people on the writing group, the 39 people on the writing group, what their field of interest and or specialty or expertise was. So it not only included people in interventional cardiology, but it included a diverse group of people with involved specialties whose Venn diagram kind of overlap parts of our practice. And this includes such fields as cardiac anesthesiology, cardiothoracic surgery, cardiovascular imaging, be it MRI or CT or echo imaging, general cardiology, geriatric cardiology, a whole field involving the whole field of quality assurance and systems of care. We also had diversity in terms of the training and the background of the people on the writing committee. This includes things such as people who had degrees as nurse practitioners, as physician assistants, as interventional cardiologists in training, and members who represented a diversity, not only in the stage of their career, whether it was late stage, middle stage, early stage, in the atmosphere of their practice, whether there were large active laboratories or smaller, more rural laboratories, but also there was a diversity in the geographic distribution, gender distribution, ethnicity, and race. So it's really a wide span of practitioners that were involved in trying to put this together. All the members of the writing committee, of course, met the ACC requirements, that 50% plus my position had to have no conflicting industry relationships, 50% of the writers, and we met that standard. So if we go ahead here. As Doug mentioned briefly, we, the partners in this endeavor were led by the American College of Cardiology, the American Heart Association, and our society, the Society of Angiography and Coronary Interventions. The collaborators, you can see here, there were 10 other collaborators, 10, 11 other collaborators, including the Society of Thoracic Surgery, vascular surgeons, imaging societies, as I had mentioned previously, people involved with heart failure, HRS, the Cardiac Anesthesiology Society, interventional radiology and vascular people involved in vascular medicine. Peer review was not only extensive, but it was transparent. The peer review involved interventional cardiology program directors, open surveys on the proposed procedural numbers, which I suspect will be the subject of some discussion later on in this hour. There was also a peer review open to public comment. We had 63 invited peer reviewers and simultaneous public commentary processes, all adjudication of this over 740 responses we got from our reviewers were adjudicated by groups, many of whom were on this leadership group that's presenting some of the information to you during this meeting. So to summarize, it was a long, and it was somewhat laborious, interesting two-year conversation with a lot of different angles and a lot of different interests sitting at the table and we had a lot of open and free dialogue. If we look at competency tables, this is really the heart of a court, as Doug also mentioned, it's really the basis as the ACGME looks on medical education, building these foundational blocks toward competence. Competence in cognitive areas we've always been pretty good at through the history of medical education. We have board certification exams. We all had to pass numerous exams while we were pre-meds and in med school. So it's an area that we've always had strains. But in surgical or procedural specialties, it's always been somewhat controversial how to best judge or assess or more importantly teach competence. And through the years we've used different surrogates. Volumes, number of cases, mimicking exposure, do the number of cases, are they sufficient to realize a broad base of what we might see when we go out to practice? Will we be exposed to complications? Lots of things go into this. Or another measurable end point would be the time we spent training in a certain specialty. But really what we want with competence is how do we know that we're teaching toward competence, that people are involved in a process where they'll be learning consistently through training and have the building blocks available. So when they choose the field that they go into to practice their interventional specialty, they will have adequate exposure, adequate experience, and an interaction where their program directors and the associated faculty can do adequate evaluation of their competencies. These are the domains of the ACGME. As you can tell, they're medical knowledge, patient care and procedural skills. You can see them broken down on this table. This is table one in the document. And you can see they're broken down into several more specifics. You can all refer to this. And these are the other professional behavioral competencies that we've talked about in the past. And if you look at evaluation tools, you can see at the bottom of both of these columns, some tools that have suggested they're just part of the document. The other things that we've talked about at length are procedural numbers. What's meant by procedural numbers and how did we come to these? Well, they're meant to be guidance to set a floor for experience and exposure. Competencies for the competent to attain the competence delineated in the competency tables. Those are meant to serve as a guide, not as a black and white number, an absolute cutoff, but as a floor to experience. Certainly, people could have more experience. We've all trained many fellows through the years. I know I've trained hundreds of fellows. Some fellows may get it after 200 cases. Some fellows may get it after 250 cases. Some fellows may never get it. So that relationship is far from linear or consistent. And it recommends minimal numbers that are sufficient to provide trainees with the exposure to a variety and the spectrum of complex clinical case material. And it gives the supervising physician, such as ourselves, sufficient opportunity to evaluate training competency. And that's how we came to these numbers. And we're going to drill down on that in a little bit more detail, Dawn. And starting with the coronary block. Thanks.

competencies

procedural numbers

training standards

coronary vascular

peripheral vascular